1. Domain 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transportation, and Storing Instruments and Supplies- (12%-22 Questions)
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2. Objectives
Identify the topics in Domain 6 and their corresponding elements.
Apply elements and topics to the chapters and module in the study guide.
Identify additional resources available.
Assess your current knowledge.
Develop a study plan.
Identify your assignments.
The objectives of this presentation are:
Identify the topics in Domain 6 and their corresponding elements
Apply elements and topics to chapters and modules in the study guide
Identify additional resources available
Assess your current knowledge
Develop a study plan
Identify your assignments
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3. Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 1: Microbiological Considerations Related to Infection Control Principles
Topics:
Handling and disposition of biohazardous materials
Microbiology
Standard and transmission-based precautions
Elements (your nursing interventions)
Use appropriate Personal Protective Equipment (PPE)
Describe appropriate handling and disposition of hazardous materials (blood, infectious pathogens such as Creutzfeldt-Jakob Disease [CJD])
PPE is the first line of defense for personnel safety against contaminants. In the intraoperative area it is an expectation that staff don PPE. During the cleaning and disinfecting of instrumentation, staff should wear PPE to protect against any possible contamination from hazardous materials, as well as cleaning solutions that may splash on staff. Refer to the SRP for recommendations related to PPE when performing cleaning and disinfecting. How do these compare to your facility policies?
Staff are exposed to hazardous materials throughout the perioperative process. During surgery there is a risk for exposure to blood and other infection pathogens. Using universal precautions and PPE will decrease the risk of transmission from these pathogens. CJD is not a common diagnosis among patients. There are specific precautions when dealing with a known case of CJD. Disposable instruments shoujld be used whenever possible. Specific decontamination processes are discussed in the reference texts. Other hazardous materials used in the OR may include chemicals, bone cement, and some medications. The SDS should be readily available for those items used in your department.
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4. PPE
The Centers for Disease Control and Prevention (CDC) has created a PowerPoint® presentation on the use, application, donning, and discarding of proper PPE materials.
Play CDC slide show now
PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA.
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5. Additional Resources CDC - Creutzfeldt-Jakob Disease, Classic (CJD)
The CDC has a webpage dedicated to CJD. There is an overview of the disease process. In addition, on the right hand side of the page are links to additional pages. The hyperlink for infection control will direct you to a page that discusses the effect of contaminated instruments have had on patients. It also discusses how to care for instruments related to CJD.
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6. Use Appropriate PPE
Eyewash stations must be available for exposure to any hazardous material. The station must be located within _________ from the location of possible exposure.
5 seconds
10 seconds
15 seconds
30 seconds
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7. Answer
B. 10 seconds
SRP (2014), Safe Environment of Care: IX.i.3. (p. 244).
The eyewash station must be located within 10 seconds from areas where exposure may occur and immediately available if the exposure is related to a caustic or strong acidic chemical.
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8. Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 2: Cleaning and Disinfecting Instruments and Supplies
Topics:
Regulatory requirements for tracking of materials and instruments brought in from outside the facility.
Principles of cleaning and disinfection.
Professional (AORN Perioperative Standards and Recommended Practices, Association for Advancement of Medical Instrumentation [AAMI]) and regulatory standards (Occupational Safety and Health Administration [OSHA], Centers for Disease Control [CDC])
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9. Elements (your nursing interventions):
Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Elements (your nursing interventions):
Choose the appropriate method for cleaning and disinfection of contaminated equipment and instruments.
Manage materials and instruments brought in from outside the facility.
Instruments and equipment require different cleaning and disinfection methods. Anesthesia equipment has its own requirements for decontamination. “Proper handling and processing of medications, supplies, and equipment can reduce the risk of infection to the patient” (SRP 2014, p. 507). The SRP has recommendations related to anesthesia equipment, high-level disinfection, endoscopy equipment, instruments, and packaging systems. This is an area of practice that most perioperative nurses feel they need more knowledge. Reviewing these recommendations will assist the perioperative nurse with a better understanding of these topics.
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10. Additional Resources
Association for the Advancement of Medical Instrumentation (AAMI)
Summit Report: Priority Issues From the AAMI/FDA Medical Device Reprocessing Summit.
40 page report of summit findings
Video from NBC
Dirty Instruments Hurt Patients
“In October 2011, more than 275 participants convened at the FDA headquarters in Silver Spring, MD, for a multidisciplinary AAMI/FDA Medical Device Reprocessing Summit.” ( You can search this link to find information that was collaborated on at the summit.
In 2012, NBC News ran a video about the cleaning and disinfection of instruments. Only one state requires that instrument technicians be certified. Watch the video to see what may be happening at your facility.
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11. All instruments used on the patient All instruments
Choose appropriate method for cleaning and disinfection of contaminated equipment and instruments
_______ on the table during a surgical procedure require decontamination before processing to the required level of safety for patient use.
All instruments used on the patient
All instruments
All visibly soiled instruments
Only instruments contaminated
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12. Answer B. All instruments
B&K. (2013). Chapter 17: Decontamination and disinfection: Instrument cleaning and disinfection. (p. 287).
“All instruments on the table during a surgical procedure require decontamination before processing to the required level of safety for patient use.”
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13. Module 3: Packaging and Sterilization of Instruments and Supplies
Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 3: Packaging and Sterilization of Instruments and Supplies
Topics:
Principles of packaging and sterilization.
Elements (your nursing interventions):
Select appropriate packaging.
Determine appropriate sterilization method.
Select appropriate method(s) for biological/chemical monitoring.
Your supplies/instruments are most likely packaged in your central sterile supply department. Perioperative nurses need to be aware of appropriate packaging to determine if package integrity is maintained for sterility. Items that are limited as far as inventory may need to be reprocessed. Time will determine the method used for reprocessing. Immediate Use Steam Sterilization (IUSS) previously known as “Flash” sterilization is highly discouraged. If time permits, the best practice for reprocessing is to send the item to central sterile processing for decontamination and sterilization.
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14. Determine appropriate sterilization method
In using a dynamic air removal (pre-vac) sterilizer to sterilize a set of wrapped instruments, which of the following indicates the proper cycle:
3 minutes at °C (250 degrees F).
4 minutes at °C (270 degrees F).
10 minutes at °C (250 degrees F).
10 minutes at °C (270 degrees F).
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15. Answer B. 4 minutes at 132.2°C (270 degrees F).
SRP. (2014). Sterilization: Table 4. (p. 581).
The AAMI recommendation for dynamic air removal steam sterilization for wrapped instruments is 4 minutes at 270 degrees F.
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16. Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 4: Principles of Transporting and Storing Sterile Supplies
Topics:
Environmental conditions of sterilization and storage areas.
Principles of transporting and storage.
Elements (your nursing interventions):
Select appropriate methods for transporting and storage of processed supplies and instruments.
Monitor environmental conditions (humidity and temperature) of sterilization and storage areas.
The transportation and storage of sterile supplies can have a huge impact on patient safety. Guidelines and regulations need to be followed in order to maintain the sterility of items. Patient’s depend on the health care team to perform best practices to maintain their safety. There are recommendations for humidity and temperature control in areas where supplies are stored. The recommendations are included in your reading assignments.
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17. contamination by dust collection.
Select appropriate methods for transporting and storage of processed supplies and instruments
Warm or hot items should not be unloaded from a sterilizer onto a cool surface because it could cause:
contamination by dust collection.
mixing of sterile and non-sterile items.
the potential for steam condensation.
accidental damaging of delicate instruments.
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18. Answer C. the potential for steam condensation.
SRP. (2014). Sterilization and Disinfection: VI.d.1., p. 581.
The combination of temperatures may lead to condensation and moisture within the sterile packages or containers. Any time a sterile item has moisture within or on it, the item must be considered unsterile.
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19. Module 5: Principles of Biological and Chemical Monitoring Topics:
Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 5: Principles of Biological and Chemical Monitoring
Topics:
Documentation requirements for sterilization, biological, and chemical monitoring.
Elements (your nursing interventions):
Document actions related to cleaning, disinfecting, packaging, sterilizing, transporting, and storing instruments and supplies.
In your facility you are required to keep many logs. This is a federal regulation. When The Joint Commission comes for their survey they look at these logs to ensure that sterilization and storage processes are within the safe limit for patient care. IUSS sterilization logs are one form of log. These logs should be very minimal. IUSS should be done only in extreme urgent instances. In most cases, this is being performed when there is limited supply of instrumentation. Any implants that are being kept in freezer must have a log. Fluid warmers have a log. All of these are items that need to be monitored daily.
IUSS should be performed only in extremely urgent instances, and should not be used in place of adequate inventory of instruments. Logs must be maintained documenting load parameters and other information for all sterilization processes including IUSS. These logs may be reviewed during accreditation or regulatory surveys or visits to verify that standards of practice for safe patient care are being met. Other types of logs that are usually maintained in the perioperative area include tissue or implant logs and logs for fluid and blanket warmers or other equipment that must be checked on a recurring basis (daily, weekly or monthly).
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20. Document actions related to cleaning, disinfecting, packaging, sterilizing, transporting, and storing instruments and supplies
Class 5 chemical integrating indicators should be used to monitor sterilizers used for IUSS. How often should these Class 5 devices be used?
Every load.
Monthly.
Weekly.
Daily.
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21. Answer Every load. SRP. (2014). Sterilization, VII.c.3., p. 582.
Biological indicators and chemical indicators should be used to monitor sterilizer efficacy and assess compliance with established monitoring standards. Class 5 chemical integrating indicators should be used within each sterilizer container or tray.
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22. Elements (your nursing interventions):
Chapter (Domain) 6: Cleaning, Disinfecting, Packaging, Sterilizing, Transporting, and Storing Instruments and Supplies
Module 6: Safe Handling Practices for Hazardous and Biohazardous Materials
Topics:
Handling and disposition of hazardous materials.
Elements (your nursing interventions):
Describe appropriate handling and disposition of hazardous materials (chemotherapy medications and radioactive materials).
The operating room has many materials that are considered hazardous or biohazardous. Knowing where and how to access your SDS is very important for worker and patient safety. Items that you use on a daily basis or more frequently you will be more familiar with.
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23. Describe appropriate handling and disposition of hazardous materials
Formaldehyde may be used in a gaseous or liquid form. The vapors are toxic to the:
skin.
gastrointestinal tract.
eyes.
respiratory tract.
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24. Answer D. respiratory tract.
B&K (2013), Chapter 13: Potential source of injury to the caregiver and patient, p. 228.
“Formaldehyde may be used in a gaseous or liquid form. The vapors are toxic to the respiratory tract.”
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25. Study Plan Review your facilities policies related to Domain 6.
How often do you use IUSS?
Locate the temperature and humidity monitors?
Spend a day observing in CSP.
Locate outdates on suture and miscellaneous items.
Check package integrity in instrument store room.
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26. Assignments Study guide. Next presentation Read Chapter 6
Complete reading assignments
Complete activities
Next presentation
Case study applying domain 6
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